- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.43 / $338.26 / $634.01
| Professional | | $241.43 | $338.26 | $634.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.29 / $432.59 / $1,325.61
| Professional | | $356.29 | $432.59 | $1,325.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.26 / $363.41 / $972.13
| Professional | | $254.26 | $363.41 | $972.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.61 / $492.19 / $972.13
| Professional | | $330.61 | $492.19 | $972.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.29 / $479.46 / $1,393.82
| Professional | | $379.29 | $479.46 | $1,393.82 |